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Clin Med- Neuro > Seizure Lecture > Flashcards

Seizure Lecture Flashcards

1
Q

Paroxysmal event due to abnormal CNS discharge with resultant manifestations

5-10% of gen pop will have

More prevalent in childhood and later adulthood

A

Seizure

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2
Q

2 big classes of seizures?

A

Partial

Generalized

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3
Q

Deranged area of cerebral cortex, often due to a STRUCTURAL ANOMALY most commonly

usually no LOC (but some exceptions)

A

Partial seizure

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4
Q

2 classes of partial seizures?

A
  1. Simple (NO LOC)
  2. Complex (LOC)
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5
Q

Diffuse region of brain firing simultaneously

often due to WIDESPREAD problem
(ie.. cellular disorder, biochemical disruption, structural issue)

A

Generalized seizure

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6
Q

NO LOC**

EEG shows abnormal impulses in FOCAL area of brain*

Often clonic with repetitive flexion/extension
(ie..may get hand tremor on opposite side of abnormal brain activity)

A

Simple partial seizure

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7
Q

Jacksonian March
Todd’s Paralysis
Epilepsia Partialis Continua

..subcategories of which type of seizure?

A

Simple partial seizure

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8
Q

Motor activity begins distally (i.e. fingers) and spreads to whole extremity

..this describes which subcategory of simple partial seizures?

A

Jacksonian March

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9
Q

Local paresis that can last minutes to hours

..this describes which subcategory of simple partial seizures?

A

Todd’s paralysis

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10
Q
  • Changes in somatic sensation (parasthesias)
  • Change in vision
  • Change in equilibrium
  • Autonomic changes (flushing, sweating)

More symptoms seen in…..

A

Simple partial seizures

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11
Q

FOCAL activity progresses to loss of contact with environment (ictal state)

*stare
*amnesia

A

Complex partial seizures

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12
Q

Often begins with aura Followed by ictal state:
involuntary behaviors, picking, chewing

*can last seconds to hours

A

Complex partial seizures

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13
Q

Partial seizures that occur in the FRONTAL LOBE are more likely to have….

A

secondary generalization

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14
Q

A seizure that begins as a partial seizure
electrical discharge spreads and both hemispheres become involved

*results in TONIC CLONIC seizure

A

Partial seizure with secondary generalization

*common when partial seizures are in the frontal lobe

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15
Q

Arise in both cerebral hemispheres simutaneously

include: Absence and Tonic-Clonic

A

Generalized seizures

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16
Q

brief LOC without postural control
usually lasts a few seconds
NO POST ICTAL STATE

other subtle findings:
Eye blinking, chewing, clonic movements of hands

A

Absence seizure

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17
Q

Onset is childhood
4-8 yo or early adolescence

account for 15-20% of childhood seizures

“day dreaming” or ADD like presentation

A

Absence seizure

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18
Q

EEG will show symmetrical discharge
spikes and waves

will worsen with hyperventilation maneuver*

A

Absence seizure

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19
Q

Grand mal
10% of patients with epilepsy

MC type of seizure due to metabolic derangement

*suddent onset!

A

Tonic-clonic seizure

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20
Q

Increased muscle tone
Cry out/moan
Secretions pool
Cyanosis
Jaw clenches, can bite tongue
Sympathetis sxs: increase in BP and HR, pupil dilation

..which phase of a tonic-clonic seizure?

A

Tonic phase

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21
Q

Muscles relax and contract
usually lasts about 1 minute

..which phase of a tonic-clonic seizure?

A

Clonic phase

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22
Q

Unresponsive
Flaccid
Salivation or airway obstruction
Incontinence

Which phase of tonic-clonic seizure?

A

Post ictal phase

*can be mins to hours before awakening

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23
Q

Headche
Fatigue
Muscle aches

..what phase of a tonic-clonic seizure?

A

Post seizure

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24
Q

EEG showing:

Increased low voltage fast activity
High amplitude polyspike discharges

..which phase of tonic-clonic seizures?

A

Tonic phase

25
Q

EEG showing:

Spike and wave activit develops

..which phase of tonic-clonic seizure?

A

Clonic

26
Q

EEG showing:

slowing then recovery

..which phase of tonic-clonic seizure?

A

Post-ictal

27
Q
A
28
Q

Atonic and Myoclonic seizures are variations of…

A

Tonic-clonic seizures

29
Q

A variation of T-C seizures

1-2 seconds loss of motors tone
brief LOC
no post ictal confusion

A

Atonic seizures

30
Q

A variation of T-C seizures

brief contraction or jerk
seen in brain injuries

(the movement you get before you fall asleep)

A

Myoclonic

31
Q

Juvenile Myoclonic Epilepsy
Lennox Gastaut Syndrome
Mesial Temporal Lobe Epilepsy

…subcategories of what type of seizures?

A

Generalized seizures

32
Q

Seen in adolescence
bilateral jerk without LOC

*worse with awakening and sleep deprivation

*benign..good response to tx. often self resolve

A

Juvenile Myoclonic

33
Q

Multiple types…seen in children

Associated with CNS disease:
Developmental delay
Trauma
Infection
Neural injuries

*usually impaired cognitive function

A

Lennox Gastaut

34
Q

Partial epilepsy with characteristic features

MRI shows hippocampal sclerosis***

A

Mesial temporal

35
Q

Shift in balance of excitation and inhibition in CNS

Mechanisms:
Change in threshold (ie fevers)
Genetics
Traumatic brain injury
Other events: stroke, infections
Other factos:
-stress, sleep deprivation, menses, meds

A

Etiology of seizures

36
Q

Burst of electrical activity..influx of extracellular calcium*
Exctiatory moleciles, like NMDA may further Ca influx

Spike discharge
Inhibitory neurons overwhelmed by Ca and K
Propogation of APs

A

What goes on during a seizure

37
Q

birth injury
congenital abnormalities
maternal drug use

..causes of seizures in?

A

Neonates

38
Q

MC cause of early childhood seizures?

A

Fever!

(febrile seizures)

39
Q

usually occurs 3mos to 5 years

often caused by:
otitis media, respiratory infection, gastroenteritis

recurrence occurs in about 1/3 of patients

A

Febrile seizures

40
Q

When does epilepsy become apparent?

A

During childhood

41
Q

What must you think about if an adolescent has a seizure?

A

Trauma!

*worse trauma= worse seizures

42
Q

What is the cause of 50% of new onset seizures in adults?

A

Cebrovascular disease

43
Q

Cerebrovascular disease
Trauma
CNS tumor
Degenerative disease
Medical (hypo/hyper glycemia, renal failure, liver dz, drugs)

A

Causes of seizures in adults

44
Q

Which one is inhibtory? Which one is excitatory?

  • Glutamate
  • GABA
A

Glutamate= excitatory

GABA= inhibitory

(seizure meds target these)

45
Q

Alpha: 8-13 Hz
Beta: >13 Hz
Theta: 4-7 Hz
Delta: <4 Hz

..these can be determined by which diagnostic?

A

EEG

46
Q
  • Awake/sleep
  • Eyes open/closed or with photo stimulation
  • Hyperventilation
  • Sleep deprivation

..all of these states should be assessed with?

A

EEG

47
Q

Abnormal activity that starts/stops abruptly
Abnormal activity during T-C seizures
Inter-ictal may see sharp spikes or waves (40%)..worse prognosis

A

Key findings on EEG

48
Q

EEG

Imaging (MRI=best!!)

Blood test (usually norm, prolactin may be increased within first 30 mins)

A

Work up for seizure

49
Q

Block activity of ion channels or neurotransmitters
Inhibit Na dependent APs
Inhibit Ca channels
Decrease glutamate release
Increase GABA availability

A

Mechanisms that seizure meds work

50
Q

Blocks voltage dependent calcium channels, modulating excitatory neurotransmitter release

Gabapentin or Pregabalin?

A

Gabapentin

51
Q

Binds alpha2-delta subunit of calcium channels, decreasing NT release,
producing anti-nociceptive and anti-seizure effects

Gabapentin or Pregabalin?

A

Pregabalin

52
Q

When would you take a pt off seizure meds?

How would you do it?

A

Can try taking off if:
Low risk
1 seizure then seizure free
Normal exam
Normal EEG

must take off meds slowly! taper!

53
Q

Continuous seizure
(seizures follow one another without recovery of consciousness between)

Some say if more than 15-30 mins
Others if > 15 seconds
May range from T-C seizure to more subtle (finger or eye movement)
May need EEG to verify

A

Status epilepticus

54
Q

Medical emergency!
Cardiovascular implications
Hyperthermia
Metabolic derangements
CNS injury

A

Status epilepticus

55
Q

Metabolic problems
Drug toxicity
CNS infection or tumor
Head injury
Refractory epilepsy

..can all cause?

A

Status epilepticus

56
Q

How do you stop/treat status epilepticus?

A

Benzos!

Phenytoin

Phenobarbital

57
Q

What does a vagal nerve stimulator do?

A

Increase seizure threshold

(this is a bipolar electrode in the left vagal nerve)

58
Q

Seizures characterized by an aura, followed by impaired consciousness lasting seconds to minutes

N/V, focal sensory preceptions and focal tonic or clonic activity may accompany

A

Complex partial

59
Q

EEG will show spike and wave activity

A

Absence seizure

(Tonic clonic seizures will have generalized rapid spiking)

Clin Med- Neuro (10 decks)

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